What Do These Dental Insurance Terms Mean?

Understanding dental insurance terms will help you make informed decisions about your dental care coverage and maximize your insurance benefits.

Here’s an overview of the most common terms, each linking to a detailed explanation.

• Premium: A premium is a fee you pay monthly, quarterly or annually for your dental insurance coverage. [Read More]
• Waiting Period: A waiting period is the time you might have to wait after enrolling in a dental insurance plan before you can receive coverage for certain procedures. [Read More]
• Network Dentist: A network dentist, also known as an in-network dentist, is a dental care provider who has contracted with your dental insurance company to offer services at pre-negotiated rates. [Read More]
• Benefit Period: A benefit period is a specific timeframe, such as 12 months, during which your dental insurance benefits, coverage and restrictions apply. This period determines how your dental benefits are administered and how your coverage is calculated. [Read More]
• Types of Dental Treatments: Dental treatments are typically categorized into three main types:

• Preventive and diagnostic
• Basic
• Major

Each category serves a different purpose in maintaining and restoring oral health, with varying levels of insurance coverage, complexity and cost. [Read More]

• Deductible: A deductible is the amount you must pay out-of-pocket for dental services before your insurance begins to cover costs within a specific period of time or benefit period, e.g., a calendar year. [Read More]
• Copay: A copay, short for co-payment, is a fixed amount you pay for a medical or dental service at the time of the visit. It does not necessarily cover the entire cost of your visit. [Read More]
• Co-Insurance: Co-insurance is the percentage of the cost you pay for a dental procedure after you’ve met your annual deductible. It’s also referred to as cost-sharing. [Read More]
• Annual Maximum: An annual maximum in a dental plan is the total amount your dental insurance will pay for dental benefits for each person covered by the plan within the benefit period, e.g., a year. Once this limit is reached, you are responsible for all additional costs until the benefit period resets. [Read More]
• Claim: A claim is a request for payment that you or your dentist submit to your dental insurance company after you receive services. [Read More]
• Explanation of Benefits: An explanation of benefits (EOB) is a statement from your dental insurance company that details how much it covered of the dental services you received. It will also specify your share of the costs. [Read More]
• Pre-Determination of Benefits: A pre-determination of benefits is an estimate from your dental insurance company of how much it will pay for a proposed dental procedure. [Read More]
• Out-Of-Pocket Expenses: Out-of-pocket expenses, frequently referred to as OOP expenses, are the costs that you—not your dental insurance—pay for dental services. [Read More]

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